Endoscopic papillotomy: impact on community hospital treatment of common duct stones

Abstract

High mortality rates reported with common bile duct exploration (CBDE), 3.4 per cent to as high as 30 per cent in re-exploration of those over 70 years of age, prompted review of endoscopic papillotomy (EP) for stone extraction in a community hospital as well as an attempt to assess its impact on the treatment of common duct stones. Endoscopic papillotomy in 237 patients had a 1.3 per cent mortality. Successful extraction of the stone occurred in 91.6 per cent of 108 patients followed for at least 2 years with no further treatment required. Morbidity and mortality was uneffected by previous biliary surgery, repeat attempts at stone extraction or EP performed prior to cholecystectomy (P greater than 0.1). The results of treatment for choledocholithiasis in 111 consecutive patients was then retrospectively reviewed to assess the impact of endoscopic papillotomy. CBDE was used initially in 79 and EP in 32 patients. Previous cholecystectomy and age biased the selection for endoscopic papillotomy (P less than 0.01). The mean ages were 57.8 years and 70.6 years (P less than 0.01), for CBDE and EP pts respectively. Age adjusted hospital stay was significantly longer for common bile duct exploration (P = 0.002). Overall, morbidity was not different between the treatment modalities (P = 0.50) and each group had one death (P = 0.23). In this community hospital, endoscopic papillotomy is safe, effective, and was reserved mainly for older patients or those with prior cholecystectomy and choledocholithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)